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July Edition 2019

Inside This Issue

Antidepressants: What Is the Best Medication for Depression?

Learning About the Different Antidepressants and Treatments for Depression Can Help You Become the Best Advocate for Your Mental Health By Katherine Hancock

W St. David’s Medical Center Opening new Electrophysiology Center See pg. 12

INDEX Financial Forecast............. pg.3 Oncology Research......... pg.6 New Technology................ pg.8 Healthy Heart..................... pg.10

The Renewed Demand for Radiologists See pg. 13

ith 322 million people in the world suffering from depression, it comes as no surprise that those diagnosed with depression experiences different signs and symptoms of the condition. The symptoms of major depressive disorder, or clinical depression, may affect how you feel, think and handle everyday activities. “With a combination of therapy and antidepressants, most people with depression can find a treatment plan that works for them,” said Joy Alonzo, PharmD, MEng, specialist in the pharmacotherapy of mental disorders and a clinical assistant professor of pharmacy practice at the Texas A&M College of Pharmacy. “However, everyone will respond differently to each antidepressant, so you need to work closely with your health care providers to find what works best for you.” Signs and symptoms of depression Depression can present as a constant, persistent feeling of sadness or depressed mood nearly every day for at least 2 weeks can be associated with loss of interest in activities, weight gain or loss, fatigue, feelings of worthlessness or guilt, decreased ability to concentrate, sleep disturbances or thoughts of suicide. “Everyone feels sad sometimes,” Alonzo said. “However, depression is not something that easily gets better on its own. There are many treatments, including therapy and medications, that can help.” Persistent thoughts of suicide with or without a specific plan can constitute a medical emergency and should never be taken lightly. If you or someone you know is having thoughts of suicide, please call 911 and ask for mental health responders. If you are worried that you might be

experiencing symptoms of depression, speak with your health care provider. There are easy to answer screening tools your health care provider can administer and they can help set you up with a treatment plan. Treatment plans including a therapist are available for all budgets, including those who might not have health insurance. Depression looks and feels differently for each person. However, some common depression symptoms are… • Depressed mood most of the day, nearly every day • Loss of interest in activities that used to give you pleasure • Weight loss or weight gain, or changes in appetite • Difficulty concentrating, or feeling like your thoughts and movements are slow • Lack of energy • Trouble sleeping • Reduced appetite • Feelings of worthlessness • Recurrent thoughtsof death or suicide, with or without a specific plan SSRIs and SNRIs for depression SSRIs (selective serotonin reuptake

inhibitors) and SNRIs (serotonin and norepinephrine reuptake inhibitors) are some of the most commonly prescribed antidepressants. These drugs work by restricting the reuptake process of important neurochemicals that regulate mood, sleep and appetite. By restricting the reuptake of these important neurochemicals, the brain has more of those chemicals to send across brain tissue. Specifically, these drugs can inhibit the reabsorption of serotonin, norepinephrine and dopamine—all chemicals that directly influence feelings of happiness and stress. By increasing the amount of these important neurochemicals, the brain is able to better regulate mood, sleep, appetite and other feelings that contribute to depression. “Since SSRIs and SNRIs work by influencing your natural brain chemistry, you may need to wait four to 6 weeks to see the full effect of these medications. Often patients will see a slight decrease in symptoms in about 2 weeks, which is when your healthcare provider will want to see you to check see Antidepressants... page 14

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Financial Forecast Business Entertainment and Meals Under the New Tax Law – What Physicians Need to Know By Reed Tinsley, CPA CVA, CFP, CHBC

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ax reform has had a significant impact on the tax deductions you can now claim for business entertainment and meals. The new tax law also eliminated business deductions for entertainment.

As a result, no deduction is allowed with respect to: (1) an activity generally considered to be entertainment, amusement or recreation; (2) membership dues with respect to any club organized for business, pleasure, recreation or other social purposes; or

Description

Amount Deductible 100%

Meals with clients and prospects Entertainment with clients and prospects Employee meals for convenience of employer

Employee meals for required business meeting Meal served at Chamber of Commerce meeting Meals while traveling away from home overnight Year-end party for employees and spouses  Golf outing for all employees and spouses  Year-end party for customers Meals for general public at marketing presentation  Team-building recreational event for all employees  Golf, theater, or football game with your best customer

50% Zero

       

(3) a facility or portion thereof used in connection with any of the above items. Under prior law, there was an exception to this rule for entertainment, amusement, or recreation directly related to (or, in certain cases, associated with) the active conduct of a trade or business. This is no longer the case. The chart on the left shows you how the Tax Cuts and Jobs Act treats 12 meal and/or entertainment events. In Notice 2018-76, the IRS states that client and prospect business meals continue as

tax deductions under the Tax Cuts and Jobs Act. This is very good news indeed. Under this new IRS guidance, you may deduct 50 percent of your client and prospect business meals if 1. the expense is an ordinary and necessary expense under Internal Revenue Code (IRC) Section 162(a) that is paid or incurred during the taxable year in carrying on any trade or business; 2. the expense is not lavish or extravagant under the circumstances; 3. the taxpayer, or an employee of see Financial Forecast...page 14

Women in Media Psychology Dorothy Andrews (at right in front) is joined by her Fielding Graduate University professors. Dorothy is currently working on a PhD in Media Psychology where she is studying how media technologies are affecting perceptions of risk aversion, neutrality, and affinity. Dorothy Andrews is the Chief Behavioral Data Scientist and Actuary for Insurance Strategies Consulting LLC.

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Dell Medical School Recognizes Community Members for Excellence in Health Leadership Awards Program Celebrates How Health is Happening Here

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riven by the vision of a vital, inclusive health ecosystem, Dell Medical School at The University of Texas at Austin recognized the importance of local organizations and community leaders working to improve health locally at its first ever Health Leadership Awards ceremony today. The event celebrated how Health is Happening Here in our community, saluting fifty-five individuals and organizations who were nominated by the community because they demonstrate excellence in various settings and actively play a role in improving and rethinking health. From those community-sourced nominations, nine were selected to receive the Health Leadership Award. “Community leaders have been innovating in health for a long

time, and there’s a great amount of innovation that continues to flourish in this community,” said Maninder “Mini” Kahlon, Ph.D., Vice Dean of Dell Med’s Health Ecosystem and Associate Professor in the Department of Population Health, as she praised Health Ecosystem Leaders Austin Recovery and People’s Community Clinic, represented respectively by Laura Sovine and Melissa Kaufmann. The two organizations were recognized for their innovative collaboration to provide substance use treatment while addressing the physical health needs of their patients. Among the award recipients was St. Andrew’s Episcopal School eighth-grader Ben Hofer who was named Middle School Student Health Leader for elevating the problem of

From left to right: Susan Dawson, Sen. Kirk Watson, Rhonda Mudhenk, Ben Hofer, Dr. Sanford Jeames, Dean Clay Johnston, Jose Ponce, Jessica Davis, Laura Sovine, Melissa Kaufmann.

lunch shaming within Austin ISD. He committed to organize a campaign to pay off the lunch debt first at three schools, and then for the entire school district. Dana Saltalamachia of Integral Care was honored as Health Care Practitioner Leader for her work in an interdisciplinary team that increases access to HIV/AIDS treatment for people experiencing homelessness through Integral Care’s Street Outreach Team.

Other award recipients: • High School Student Leader: Jose Ponce, Del Valle ISD. Ponce is an aspiring physician who implemented a Science Olympiad Team at his high school. “I look forward to welcoming him as a colleague in a few short years,” said Brandon Allport-Altillo, M.D. MPH, Dell Med’s Co-Director of Primary Care, Family and Community Medicine Clerkship, who introduced see Leadership...page 13

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We’re learning more about mental health every day. So can you. FEATURED COURSES

ADDRESSING ACEs: Learn how to identify, treat and reduce the effects of trauma and toxic stress and reinforce resiliency in young patients. Earn ethics CME.

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Join more than 100,000 medical professionals who get free CME with Texas Health Steps Online Provider Education. Choose from a wide range of courses relevant to your practice, including short tutorials and podcasts on topics like Medicaid guidelines, ethics and mental health — all available 24/7. Learn more at TXHealthSteps.com.

AUTISM SPECTRUM DISORDER: Learn to recognize autism spectrum disorder (ASD) in children and adolescents and provide guidelines for diagnosis, referral, and continuity of care.

Content on the Texas Health Steps Online Provider Education website has been accredited by the Texas Medical Association, American Nurses Credentialing Center, National Commission for Health Education Credentialing, Texas State Board of Social Worker Examiners, Accreditation Council for Pharmacy Education, UTHSCSA Dental School Office of Continuing Dental Education, Texas Academy of Nutrition and Dietetics, Texas Academy of Audiology, and the International Board of Lactation Consultant Examiners. Continuing Education for multiple disciplines will be provided for some online content.

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July 2019


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Oncology Research 10 Questions You Shouldn’t Be Afraid to Ask About Your Cancer Diagnosis By Shubhada Shrikhande, M.D., Texas Oncology Austin North

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o questions should be off limits when it comes to your health, yet some topics are simply hard to broach. The truth is your doctors want you to ask the tough questions, even when the answers may be difficult to hear. Below are 10 questions your oncologist wants you to feel empowered to ask so you can receive the education and support you need. What caused my cancer? Fear of the unknown can be one of the most challenging aspects of a cancer diagnosis. Some patients experience feelings of guilt or anxiety about something they did, or did not do, that may have led to developing cancer. In reality, many cancers are unpreventable. Does my diagnosis mean my family

is at an increased risk for cancer? According to the American Cancer Society, only about 5 to 10 percent of all cancers result directly from gene defects inherited from a parent. Family members do need to be vigilant about knowing their family history, including the type and age a family member was diagnosed, because they may need to start screenings earlier. How will you choose the right treatment plan for me? Every form of cancer is unique, and no single treatment is right for everyone. Your cancer treatment plan is created specifically for you and your disease – and you play an integral role in developing that plan. Is my cancer curable? Interestingly, this is one of the least asked questions. Your oncologist wants to have an open, honest conversation with you and your loved ones about your diagnosis, treatment, and your path forward. Will this treatment increase my chances of survival or improve my

quality of life? Just as every patient’s cancer treatment is unique, treatment impacts everyone differently. Discuss goals for your treatment, managing side effects, and expectations for short- and long-term treatment results. How will my diagnosis and treatment impact my sex life? It is perfectly natural to be concerned about how cancer and treatment will impact intimacy. The long-term effects of treatment can change libido and sexual function, and affect fertility, all of which can impact relationships. It’s important to have conversations about the effects and

how to address them. Should I seek a second opinion? Despite misconceptions, getting a second opinion is not considered ‘bad etiquette’. It’s a normal part of a cancer diagnosis. How can you help ease my greatest fear? Whether it’s fear of being in pain, fear of what will happen to your family, or fear of dying, communicating your fears will help your oncologist alleviate them as best as possible. Should I participate in clinical trials? see Oncology Research...page 13

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New Technology Misaligned Technology Investments Leave Healthcare Very Exposed By Mark Johnson President, Xtrii

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e see the headlines too often… another healthcare organization has experienced a breach and millions of personal health records have been stolen. While we all are growing more concerned about the exposure of our personal information, healthcare data is the most sensitive and vulnerable. For several years healthcare data has been the #1 target for hackers, and it will continue to be the prime target until healthcare organizations change

misaligned spending? One of the reasons is cybersecurity has typically been a responsibility of the Information Technology department, and traditional Information Technology leaders tend to focus on technology products, not human capital solutions and business processes. Information Technology leaders are more comfortable buying more equipment/tech products from traditional I.T. vendors. They have not evolved their focus to assess and address gaps in ongoing employee cybersecurity education, social engineering tactics, and business processes. Just buying more technology is easy, but properly fixing the gaps and business processes is far more challenging

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their investments, actions and ongoing and requires a different expertise. focus. You can easily get a new credit 2. Engage the right expertise: card number but fixing your Electronic Healthcare organizations must Medical Record when it is stolen/ also engage the right experts to hacked is a different story. advice, educate and drive these Why does this problem continue? improvements. Leaders must The top reasons and potential solutions reevaluate their subject matter are: experts to engage new vendors/ 1. Misaligned Spending: 78% of advisors that are true experts on healthcare cybersecurity spending these modern-day threats and are is on technology, and only 1% is the more appropriate resources spent on human capital solutions. for these new challenges. It’s Yet, 68% of breaches are caused by a different expertise than employee behavior, not technology what traditional healthcare hardware. Shockingly, only 1% technology vendors provide, of cybersecurity investments and it’s typically not found are being spent on the area that internally within most causes the majority of breaches. healthcare organizations. To One of the world’s most famous be done successfully, it requires Hackers, Kevin Mitnick, recently a special expertise with in-depth stated “Companies spend millions knowledge of healthcare of dollars on firewalls, encryption workflows, business processes, and secure access devices, and technology, cybersecurity, and the it’s money wasted; None of these optimal solutions. measures address the weakest link in the security chain … People.” see New Technology...page 13 What has caused this

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Healthy Heart Long Workdays Over Many Years May Add Up to Higher Stroke Risk By American Heart Association

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f you’re reading this in the middle of one of your usual 10-hour workdays, it might make you want to head home early. A new study from France found people who regularly worked long hours, defined as working more than 10 hours for at least 50 days a year, had a higher risk of stroke, especially if they worked those hours for 10 years or more. The association s e e m e d stronger for people younger than 50, researchers said. The study, published Thursday in the American Heart Association’s journal Stroke, reviewed data from

CONSTANCES, a French study group with 143,592 participants that started in 2012; part-time workers and those who had strokes before working long hours were excluded from the study. 29 percent reported working long hours and 10 percent reported working long hours for a decade or more. In the study, 1,224 participants had strokes. Those who worked long hours had a 29 percent greater risk of stroke. Those who worked long hours for 10 years or more had a 45 percent greater risk. Study author Dr. Alexis Descatha, a researcher at Paris Hospital, Versailles and Angers University and at

...working more than 10 hours for at least 50 days a year, had a higher risk of stroke, especially if they worked those hours for 10 years or more.

the French National Institute of Health and Medical Research (Inserm), said in a news release that the findings were unexpected. Noting the long hours put in by many health care providers, Descatha was taking the results personally. “As a clinician, I will advise my patients to work more efficiently and plan to follow my own advice.” How do I know if I’m having a stroke? Men and women who have strokes often experience a similar set of symptoms that can be remembered using the mnemonic F.A.S.T.: Face

drooping, Arm weakness, Speech difficulty, Time to call 911. There are, however, other signs you should be aware of and they include problems seeing out of one or both eyes, balance or coordination problems, sudden numbness, confusion, or severe headache. When it comes to spotting stroke and getting help, the faster, the better. That’s because prompt treatment may make the difference between life and death — or the difference between a full recovery and long-term disability. Find out more at www.heart.org/stroke.

Subscribe to Our Digital Issue Now you can get the Austin Medical Times delivered straight to your inbox. Never miss an Issue of Austin’s Leading Local Healthcare News Online.

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Austin Medical Times

Texas Cardiac Arrhythmia Institute at St. David’s Medical Center opening new Electrophysiology Center

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he Texas Cardiac Arrhythmia Institute (TCAI) at St. David’s Medical Center is opening a new, state-of-the-art Electrophysiology Center dedicated to treating patients with cardiac arrhythmias. The new Electrophysiology Center is set to open at the end of the month. “This expansion at the Texas Cardiac Arrhythmia Institute is essential to helping us continue to meet the needs of our community,” David Huffstutler, president and chief executive officer of St. David’s HealthCare, said. “It will also provide additional capacity to care for a growing number of patients coming here from across the nation—and around the globe.” “Since TCAI launched more

than a decade ago, the need for specialized cardiac care for patients with rhythm disorders has increased tremendously,” Andrea Natale, M.D., F.A.C.C., F.H.R.S., F.E.S.C., cardiac electrophysiologist, executive medical director at TCAI and national medical director of cardiac electrophysiology for HCA Healthcare, said. “The newly expanded space will allow us to better serve our patients who come from all across North America, in addition to a growing number of people traveling to Austin from Asia, Europe, Latin America and the Middle East seeking care at TCAI.” The new 72,000-square-foot center includes six electrophysiology labs, equipped with state-of-the-art technology for the treatment of

complex arrhythmias; 12 dedicated beds for pre-procedure preparation; eight beds for post-procedure recovery; 20 private patient rooms; and, four private patient suites with adjoining family suites. “We are committed to providing the highest level of care for patients with cardiac arrhythmias,” Todd Steward, chief executive officer of St. David’s Medical Center, said. “The expanded space also features an international training center, which will allow TCAI to continue to share with physicians around the world the latest advances in interventional cardiac electrophysiology, improving

outcomes for patients worldwide.” TCAI’s team of 16 world-renowned physicians is one of the largest electrophysiology practices in the U.S., providing unparalleled experience, expertise and exceptional care. With this incomparable combination, TCAI successfully treats thousands of patients each year, restoring their quality of life.

Live Well Age Well Boost Your Social Interaction by Volunteering By Laura Marshall

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oday, people are more connected with one another than they’ve ever been — so why are so many of us lonely? Changes in our lives such as retirement, loss of loved ones and children moving away cause us to be isolated and contribute to loneliness. Though they can happen together, loneliness and isolation are not the same experience. Isolation refers to closing one’s social circle, while loneliness has to do with being valued and understood by others. We can be isolated and not be lonely, just as we can still feel lonely when surrounded by friends and family. Research suggests weekly social interaction can reduce loneliness, slow cognitive decline and positively impact physical health. One way to increase social interaction is through volunteering. Donating your time and experience can help curtail loneliness especially if you decide to make it a regular part of your week. Volunteering keeps your brain active by exposing you July 2019

to a variety of new people and activities, making it a great way to connect to a ready-made social circle. Start small by choosing drop-in volunteer opportunities at local events, food banks and other organizations that interest you. The Retired and Senior Volunteer Program has chapters across Texas that can match you up to local opportunities based on your time and interests. “It’s a joy to be able to help,” said Peggy Robinson , a long-time volunteer at the Harris County Area Agency on Aging, who spends about 20 hours a week helping older adults understand their rights and benefits under Medicare. “A lot of people don’t know how you can use your benefits, and I enjoy educating people about available free or low-cost programs.” A l e s s e r- k n o w n option is to

join a paid national service program such as AmeriCorps VISTA (Volunteers in Service to America), which is like a domestic version of the Peace Corps. VISTA members serve full-time for 12 months in nonprofit organizations and government agencies building the organization’s capacity to eliminate poverty. Unlike the Peace Corps, you can serve locally with VISTA. For example, in Texas Health and Human Services Commission’s Age Well Live Well VISTA project, members have worked with community partners writing grants, promoting free health and wellness classes, and engaging community members

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in a digital storytelling project. Age Well Live Well is currently recruiting two VISTA members, one to serve in Jasper, and the other in Abilene. VISTA members receive a stipend among other benefits for their service. HHS has ongoing VISTA opportunities for Age Well Live Well. To learn more, call the Age Well Live Well Hotline at 800-889-8595. A website like VolunteerMatch.org or a community newsletter will inform you about local volunteer opportunities. There are many options to expand your social circle and enrich your life as well as your community.


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New White Paper: The Renewed Demand for Radiologists Physician Recruiting Trends Seem to Go In Cycles of our most requested type of search assignments. Demand for radiologists subsequently diminished, due in part to cuts in reimbursement for radiology services and to the recession, which significantly inhibited utilization of imaging services, particularly those associated with elective procedures. In 2012, radiology dropped out of Merritt Hawkins’ list of top 20 most requested search assignments altogether. Now, it’s back. Radiology reentered our top 20 list in 2016, and in the 2018 Review of Physician and Advanced Practitioner Recruiting

Incentives, it ranked fourth among our top physician recruiting assignments, trailing only family medicine, psychiatry and internal medicine. Why the resurgence? That’s just one of the questions answered in Merritt Hawkins’ new white paper entitled Radiology Recruitment Trends and Recommendations. This new report traces the history of radiology, education and training pathways in the specialty, subspecialties, work settings, supply and demand projections, and current levels of compensation for radiologists.

includes creating partnerships Continued from page 4 with community organizations -- resulting in internships, college Ponce. credits and more. His work has • Middle School Educator Leader: inspired other schools across Texas Jessica Davis, Del Valle ISD. This to adopt similar models. high school teacher was recognized • Community Volunteer Health for promoting health sciences Leader: Susan Dawson, Central through her school’s Science Texas Breast Health Coalition. Olympiad Team. Every Monday Founder and Executive Director through Thursday, about 30 high of E3 Alliance, Dawson was school students practice after recognized for her dedication to school for the Olympiad under helping uninsured breast cancer Davis’ guidance. patients gain access to cancer care • High School Educator Leader: and her leadership of the Central Dr. Sanford Jeames, Austin ISD. Texas Breast Health Coalition. Jeames has transformed the • Transformational Health Leader: health sciences program at East Rhonda Mudhenk, J.D., MPH, Side Memorial High School Lone Star Circle of Care. for the last six years. His work Mudhenk was recognized for her

innovative methods of advancing health care and for the value she places on collaboration across the community. • Public Service Health Leader: Sen. Kirk Watson, Texas State Senate. Sen. Watson was recognized for his continuing leadership in health in Texas, including advancing support for Austin State Hospital’s Brain Health Redesign.

By Phillip Miller Merritt Hawkins

F

or example, approximately 15 years ago, there was a virtual feeding frenzy for radiologists, as hospitals, medical groups and other facilities nationwide sought physicians to read and interpret a growing number of x-rays, CT scans, MRIs and other diagnostic images. For several years, radiology topped Merritt Hawkins’ list

Leadership

Oncology Research Continued from page 6 Many factors will determine if you’re a candidate for a clinical trial, including your age, cancer type and

New Technology

Continued from page 8 3. Leadership: To address this misalignment, cybersecurity must be the responsibility of the entire organization. This critical area must receive ongoing oversight from the Board and top executives and be led with a “Business Leaders” mindset that focuses on the big

Nominees were required to meet the following criteria: • Achieving measurable improvements to health or health care; • Making creative, innovative¬ and exceptional contributions to the health ecosystem; • Re-envisioning and rethinking

It also features recommendations for recruiting these in-demand specialists, including a section on recruiting radiologists into academic settings. The paper offers insights that may be useful to anyone seeking radiologists in today’s competitive market, to those who track staffing trends, and to radiologists themselves. It is part of Merritt Hawkins’ White Paper Series on recruiting dynamics in various medical specialties.

health or health care; • Paying attention to the long-term impact and sustainability of their work; • Working diligently without significant recognition for their contributions to the health ecosystem; and • Contributing to a vital and inclusive health ecosystem. “Dell Med was created because Travis County residents decided to invest in the health and well-being of our community, so it’s befitting that we recognize the leaders within our area who are doing the tough work, day in and day out, of enacting health transformation,” said Kahlon.

stage, previous treatments, and overall medical history. Curious? Just ask. What happens if I can no longer speak for myself? Advance care planning is the process of outlining your choices

about your future medical care. This process offers peace of mind for patients and loved ones, and it also helps your oncologist ensure your values and wishes are at the forefront of your care. At Texas Oncology, we believe asking questions is the best way for

patients to stay informed about their cancer care. Bring a family member or friend for extra support, take notes, and prepare for honest discussion. You’ll be glad you did.

picture, including end-to-end business processes and the ongoing cybersecurity education of their workforce. The company’s leadership must engage, stay engaged, and be held accountable. Act like the organization’s future is on the line… because it is. “It can take 20+ years for a company to build a great reputation, but it can be destroyed in less than 20

minutes by a cybersecurity breach.” With such an extremely competitive healthcare market, a healthcare organization can’t afford to have a breach that impacts their credibility/trustworthiness. Organizations must change their cybersecurity focus and investments to human capital solutions, which assess and protect against social engineering, the exploit of human tendencies, and

gaps in business processes. Board members and business leaders must be more actively engaged in this ongoing exposure and insist on the right cybersecurity investments to address these new tactics and threats. Let’s challenge healthcare leaders to take the right actions, set the right example and provide a secure, trustworthy healthcare environment. 

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Austin Medical Times

Antidepressants

Continued from page 1 on progress. Patients often describe one of the first positive effects of taking the medication is improved sleep,” Alonzo said. “If you do not see results after a few weeks of starting a new medication, then speak with your health care provider. You may need to adjust your dosage, or need to change to a different medication. The treatment for depression is very personalized, and it is not uncommon for patients to try more than one medication before we found the one that works for you. Don’t stop taking the medication on your own.” Ketamine and esketamine for depression Ketamines and esketamines are not used as a first-line treatment for depression. They are often only prescribed when the patient has treatment-resistant depression, or depression that has not responded to other medications and therapies. Ketamine and esketamine are very similar in composition, but esketamine is remarkably more potent than ketamine. Ketamine is approved by the FDA as an anesthetic, but it is being used for treatment-resistant depression off-label, meaning it does not currently have FDA approval for this use. Ketamines and esketamines can be used for very severe or life-threatening cases of depression that include suicidal ideation that can help the person long enough to give other antidepressants adequate time become effective. Spravato© (Esketamine) nasal spray for depression In March of 2019, the U.S. Food and Drug Administration approved the use of Spravato ©, an esketamine nasal

spray, in conjunction with an oral antidepressant, for adults who have tried at least two other antidepressant medications, but have not benefitted from them. Spravato© is considered high risk and is only available through a system of tight distribution and monitoring. Spravato© is only to administered under supervision from the health care provider in a health care clinic or office and is not self-administered. Possible side effects after administration include sedation, disassociation, attention and judgement problems, and possibly worsening suicidal thoughts, patient’s will be monitored at the provider’s facility for at least 2 hours. How long does it take for antidepressants to start working? “Depending on the medication used, traditional antidepressants like SSRIs and SNRIs can take up to 4-6 weeks for full effect,” Alonzo said. “Spravato© (esketamine) is fast-acting and can potentially help those experiencing thoughts of suicide more quickly, however, it is not appropriate for long term treatment of depression. SSRIs and SNRIs provide a more long-term relief, but take longer to become effective.” Speak with your health care provider if you are not noticing an improvement in your symptoms of depression after taking your antidepressant medication every day for at least 2-4 weeks. They may decide to adjust your dosage or try a different treatment plan. Ca n a nt idepressa nt s ma ke depression worse? “Certain antidepressants can

increase the risk of suicidal thoughts in especially young people,” Alonzo said. That’s why it is important to stay in close communication with your health care provider as you or your child start a new antidepressant treatment. “Usually, your provider will recommend a follow-up appointment within one to two weeks of starting a new antidepressant to check on your progress and monitor side effects and tolerability. Finding the correct treatment plan for you can take time, but it is worth the effort.” Which antidepressant will work for me? “Once medication is deemed necessary to treat your depression, your provider will select the best medication for you and will start with a dose that is considered standard for your symptoms. The treatment of depression with medication is very personalized, and it might take more than one trial with more than one medication before we find the right one for you.” Alonzo said. “Finding the best antidepressant medication treatment plan for you may take some time, but these medications are very effective, and combined with therapy, before long we will be discussing your recovery.” If you or someone you know is struggling with untreated depression, then do not hesitate to reach out for help. Please contact 1-800-273-TALK to reach the Mental Health America 24 hour crisis line, or text 741741 at the Crisis Text Line.

food and beverages. To prove your business meals, follow the two easy steps below: 1. Keep the receipt that shows the name of the restaurant, the number of people at the table, and an itemized list of food and drinks consumed. 2. On the receipt, record the name or names of the person or persons with whom you had the meal and also record the business reason for the meal. In the event that the receipt is not available, such as with the purchase of hot dogs and drinks at a baseball game while sitting in the stands, make sure to make a written note of the expenditures

immediately after the game. If you charge a business meal to a credit card, the credit card statement provides your proof of payment. When possible, always pay by credit card or write a check so that you have clear proof of payment. Proof of payment is not proof of what you purchased, so in addition to proof of payment, keep the receipt with the notations as described earlier. With this combination of proof of payment and receipt with notations, you have what we call audit-proof documentation.

Financial Forecast Continued from page 3 the taxpayer, is present at the furnishing of the food or beverages; 4. the food and beverages are provided to a current or potential business customer, client, consultant, or similar business contact; and 5. in the case of food and beverages provided during or at an entertainment activity, the food and beverages are purchased separately from the entertainment, or the cost of the food and beverages is stated separately from the cost of the entertainment on one or more bills, invoices, or receipts. The entertainment disallowance rule may not be circumvented through inflating the amount charged for July 2019

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